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Periorbital angioedema and swelling of face and tongue: case report A 44-year-old woman developed swelling of face and tongue during treatment with ibuprofen as NSAID, and periorbital angioedema during oral challenge test with aspirin [not all routes and dosages stated]. The woman, who had a history of mild-intermittent asthma, childhood eczema and allergic rhinitis, presented for the assessment of anaphylaxis. She reported that she had made porridge using steel-cut oats containing almond milk, honey, banana, raisins and chocolate chips. She experienced itching, throat constriction and tongue swelling immediately after ingestion of porridge. She took salbutamol [Albuterol] and diphenhydramine; however, her symptoms progressed. On presentation to the emergency care, she had angioedema, cutaneous erythema, wheezing, sense of doom and dyspnoea. She did not have abdominal pain or lightheadedness. She was treated with salbutamol, epinephrine, methylprednisolone and diphenhydramine with immediate resolution of her symptoms. Three weeks later, she well tolerated the cinnamon spice oatmeal and received ibuprofen. However, immediately after ibuprofen administration and several hours after the oatmeal ingestion, she developed swelling of the face and tongue and presented to the emergency department. The woman was treated with methylprednisolone sodium succinate, diphenhydramine and epinephrine with improvement. Thereafter, she avoided NSAIDs and oatmeal. She again included wheat, chocolate, banana and almonds into her diet without any adverse event. Subsequently, after eating rice, she developed nausea, abdominal pain, general malaise and tongue tingling within minutes. Her symptoms resolved with diphenhydramine within a few hours. As per the instructions of treating physician, she brought the containers of original rice, oats and flour stored in the pantry in which she observed small crawling insects. The three containers were named bad flour, bad oats and bad rice. The oat container was found to be expired. The rice and flour were not placed in their original containers, and the expiry dates were unknown. The small insects were found in the bad flour, but not in the bad oats or rice. The insects were identified as Liposcelis bostryochophila. She underwent in-vitro studies to detect allergy to the ingested materials and aeroallergens. Skin prick test and western blots were conducted using sera from the control and the subject to detect IgE antibody against the fresh oat extract, bad oat extract, fresh rice extract, bad rice extract, crude Liposcelis bostryochophila extract and mixed dust-mite extract. Fresh oat and rice extracts were prepared by using newly purchased samples of the same brand as that of bad oats and rice. The skin prick test and in-vitro studies showed positive responses to dust mites, bad flour and bad oats. Results for fresh rice and oat were negative. Immunoblots of her serum sample yielded IgE antibodies in the extracts of the crude Liposcelis bostryochophila, bad rice and bad oat that reacted with